Individual
JOHN R CHESLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC-IT
Contact information
Practice address
626 S IRWIN AVE, GREEN BAY, WI 54301-3304
(920) 436-6800
(920) 432-5966
Mailing address
PO BOX 22308, GREEN BAY, WI 54305-2308
(920) 436-6800
(920) 432-5966
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4107
WI
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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